Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The best way to deal with a keloid is not to get one. A person who has had a keloid should not undergo elective or cosmetic skin surgeries or procedures such as piercing. When it comes to keloids, prevention is crucial, because current treatments leave a lot to be desired.
Is keloid removal necessary?
The decision about when to treat a keloid depends on the symptoms associated with its development and its anatomical location. A chronically itching and irritated keloid can be quite distracting. Keloids in cosmetically sensitive areas that cause disfigurement or embarrassment are obvious candidates for treatment. It is unclear whether early treatment is important. What is clear is that larger keloids are more difficult to treat.
Cortisone injections (intralesional steroids): These are safe and not very painful. Injections
are usually given once per month until the maximum benefit is obtained.
Injections are safe (very little steroid gets into the bloodstream) and usually help
flatten keloids; however, steroid injections can also make the flattened
keloid redder by stimulating the formation of more superficial blood vessels.
(These can be treated using a laser; see below.) The keloid may look better
after treatment than it looked to start with, but even the best results leave
a mark that looks and feels quite different from the surrounding skin.
Surgery: This is risky,
because cutting a keloid can trigger the formation of a similar or even larger
keloid. Some surgeons achieve success by injecting steroids or applying
pressure dressings to the wound site after cutting away the keloid. Radiation
after surgical excision has also been used.
Laser: The pulsed-dye
laser can be effective at flattening keloids and making them look less red.
Treatment is safe and not very painful, but several treatment sessions may be
needed. These may be costly, since such treatments are not generally covered by insurance plans.
Silicone sheets: This
involves wearing a sheet of silicone gel on the affected area for several
hours a day for weeks or months, which is hard to sustain. Results are
variable. Some doctors claim similar success with compression dressings made
from materials other than silicone.
keloids with liquid nitrogen may flatten them but often darkens the site of
Interferon: Interferons are proteins produced by
the body's immune systems that help fight off
viruses, bacteria, and other challenges. In recent studies, injections of
interferon have shown promise in reducing the size of keloids, though it's not
yet certain whether that effect will be lasting. Current research is underway
using a variant of this method, applying topical
imiquimod (Aldara), which
stimulates the body to produce interferon.
Fluorouracil: Injections of
this chemotherapy agent, alone or together with steroids, have been used as well
for treatment of keloids.
Radiation: Some doctors have reported safe and effective use of radiation to treat keloids.